CH 29 Management of patients with complications from heart disease

Question 1

preload, afterload, and contractility

Answer 1

factors affecting stroke volume (SV)

Question 2

the amount of blood presented to the ventricle just before systole

Answer 2

preload

Question 3

the amount of resistance to the ejection of blood from the ventricle.

• inversely related to SV
• determined by the diameter and distensibility of the great vessels(aorta and pulmonary artery) and the opening and competence of the SL valves (pulmonic and aortic valves)

Answer 3

afterload

Question 4

the force of contraction, is related to the status of the myocardium.
-Catacholemines can cause increase contractility and SV

Answer 4

contractility

Question 5

the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients

Answer 5

HF

Question 6

• Alteration in ventricular contraction which is characterized by a weakened heart muscle
• Ejection fracture less than 40

Answer 6

systolic HF

Question 7

less common type of HF

• characterized by a stiff and noncompliant heart muscle, making it difficult for the ventricle to fill
• Ef is normal

Answer 7

diastolic HF

Question 8

normal range 55%-65% of the ventricular volume

Answer 8

Ejection Fracture

Question 9

tries to compensate for HF by released epinephrine and norepinephrine to increase HR and contractility and support the failing myocardium, but actually has negative effects

Answer 9

sympathetic nervous system

Question 10

• left ventricle cannot effectively pump
• symptoms include an S3 sound may be heard, dyspnea, orthopnea ,PND paroxysmal nocturnal dyspnea, dry and non productive cough, can lead to frothy sputum, pulmonary edema, crackles, oliguria.

Answer 10

left sided- HF

Question 11

• right ventricle fails, congestion in the peripheral tissues and the viscera predominates.
• symptoms include JVD, edema, ascites, anorexia, nausea, weakness, weight gain, hepatomegaly and tenderness of RUQ

Answer 11

right sided-HF

Question 12

test usually performed to confirm the diagnosis of HF, identify the the underlying cause and measure the Ejection fracture(help to determine the severity of HF)
Patient will lay on left side during procedure.

Answer 12

echocardiogram

Question 13

play a pivotal role in management of HF.

-Relieve signs and symptoms of HF and significantly decrease morbidity and mortality.

Answer 13

ACE inhibitors

Question 14

this medication is contraindicated in people with systolic HF
but may be used in diastolic HF.

Answer 14

CCB’s

Question 15

lessening dyspnea, and orthopnea, decrease in crackles, relief of peripheral edema, weight loss, and increased activity tolerance

Answer 15

signs that digoxin therapy is effective

Question 16

used in patients whose HF does not improve with standard therapy. It involves the use of a biventricular pacemaker to treat electrical conduction defects.

Answer 16

CRT Cardiac resynchronization therapy

Question 17

increased systolic BP, increased ventricular wall thickness, and increased myocardial fibrosis.

• May present with atypical signs and symptoms
• Decreased renal function

Answer 17

HF in elderly patients

Question 18

procedure done to assess for HF. The patient is asked to breathe normally while manual pressure is applied over the RUQ for 30-60 secs. If neck vein distention increases more than 1cm the finding is positive.

Answer 18

hepatojugular reflex

Question 19

urine output less than 500mL/ 24 hr.

Answer 19

oliguria

Question 20

urine output less than 50mL/ 24 hr

Answer 20

anuria

Question 21

-Begin with a warm up activity
-avoid extreme weather hot or cold
-ensure you are able to talk during physical activity; if not decrease intensity
-wait 2 hours after eating
-stop if SOB, pain or dizziness occurs
-End with a cool down exercise
Some patients may need to limit physical act. to 3-5 mins.

Answer 21

safety guidelines for physical activity

Question 22

option for patients with severe fluid overload. A double lumen catheter is used and the patients blood is circulated through a small bedside machine. Liters of excess fluid and plasma are slowly removed.

Answer 22

ultrafiltration

Question 23

• Position patient upright with legs dangling over the bed(ideal)
• Oxygen
• Morphine
• Diuretics
• NTG

Answer 23

management of pulmonary edema

Question 24

occurs when decreased CO leads to inadequate tissue perfusion and initiation of the shock syndrome.

• may follow an MI
• May occur as a result of end-stage HF, cardiac tamponade, PE, CM(cardiomyopathy), and dysrhythmias

Answer 24

Cardiogenic shock